:Continuation of the Vanderbilt Center for Education and Research in Therapeutics (CERT) is proposed as part of a national collaboration to systematically improve pharmacotherapy. The theme of the Vanderbilt CERT is Encouraging Optimal Therapeutics in Medicaid and Veteran's Health Administration Populations, populations particularly vulnerable to suboptimal pharmacotherapy, underrepresented in research for a variety of reasons, and affected by managed care policies that may adversely affect therapeutics. Vulnerable groups encompassed by the CERT focus include the developing fetus, young children, low-income mothers, African Americans and other minorities, persons with mental and somatic disabilities, the chronically ill, the elderly, and persons in nursing homes. The Vanderbilt CERT realizes its mission by conducting interdisciplinary projects in conjunction with our partners that have the following 4 specific aims: 1. Improve the knowledge base for therapeutics by conducting studies of drug effects;2. Identify suboptimal provider or patient therapeutic practices;3. Conduct focused educational programs to improve therapeutics;4. Evaluate the impact of health care payer policies that may affect therapeutics. In its first three years, the Vanderbilt CERT has created an administrative infrastructure, organized 4 thematic investigator groups, and developed a collaborative network with 12 faculty. It has established strong partnerships with the State of Tennessee, the Tennessee Quality Improvement Organization, the Veteran's Administration Tennessee Valley Healthcare System and Geriatric Research, Education and Clinical Center, and the Food and Drug Administration. It has conducted 25 core projects that to date have resulted in 14 publications, 7 manuscripts under review, and 4 in preparation; and has 51 leveraged publications. In the upcoming cycle, the CERT will conduct 10 core projects and 3 partner-oriented, educational outreach/service activities. The multi-disciplinary projects include 7 research studies designed to inform provider and patient decision making in areas of clinical controversy and 3 educational programs underpinned by evidence-based guidelines and designed to reduce inappropriate variations in care. The projects include substantial representation of women, minorities, and children; and focus on high-cost disease states that are important to Medicaid, Medicare, and other federal health programs.